Thursday, 19 April 2012

Why We Believe the Hype About Flu Shots

Last Wednesday, the same day I published my previous blogpost on flu shots, John Campbell did a story on flu vaccinations on CampbellLive (TV3). He asked people on the street what they thought about flu shots. It seemed a pretty even mix between those who think they’re worthwhile, and those who don’t, and most folks he interviewed expressed pretty strong opinions. Here’s a link to the video.

In this post, I’d like to look a little closer at how flu shots are marketed to influence consumers to want to get them, and how numbers are fudged and manipulated to tell the story pharmaceutical manufacturers want you to hear.

Let’s start with a quick 15-second New Zealand ad for flu shots.

This pretty basic little ad has a catchy, rhyming slogan presenting flu as “dangerous” and “trying to get you” “even if you are fit and healthy”. Then you are told—grammatically, as a command—to “get immunised now”, implying [but, significantly, not SAYING] that immunisation[i] will protect you from catching the flu. The possibility of vaccinations being free is offered (everyone likes to get something for nothing) and “free” also suggests that the vaccinations are government-supported, which is a high stamp of approval, as is the little logo for the Ministry of Health at the end. As you can see, there’s a lot more going on in this ad than just giving you information.

TV ads are expensive, hence 15- or 30-second spots are common, and it’s hard to cram much information into such a short piece. But enforced brevity also allows plenty of wriggle-room for half-truths and implications.

I’m bothered by the implication in this ad and others that immunisation will protect you from catching the flu. As noted in my previous post, immunisation may increase your antibodies towards particular strains of flu virus, but it won’t necessarily prevent you from catching the flu. I haven’t read Osterholm’s 2011 meta-analysis[ii] of some 17 studies on the effect of flu vaccines, but Mike Adams’ article[iii] summarizing the findings says Osterholm found in these studies 2.7% of unvaccinated adults caught the flu while 1.2% of vaccinated adults caught the flu, and from that is derived a 60% protection level offered by immunisation. And in the case of the 2009 outbreak of swine flu, immunisation was correlated with an INCREASED risk of infection[iv]. (Did you catch that the above ad claims that vaccination protects against swine flu?) No study shows flu vaccines offering actual “immunity”.

I’m bothered by how these numbers are presented too. Notice that advertising for consumers suggests you have a 1 in 5 chance of catching the flu or “up to 20% chance of catching the flu”[v] (not 2.7%). The only supportable statistics that report a 20% risk rate are those referring to the 1918 Spanish Flu epidemic, which was an unusual event. See my previous post. This overstatement of infection risk, while not a blatant lie (since 2.7% certainly falls within the category of up to 20%), is misleading. And nowhere in the advertising does it suggest that vaccination increases your protection level by (just) 60%.  Advertising implies you will be “safe” if you get the vaccine.

Another statistic that bothers me is the claim that around 25,000 people die each year (in the U.S.) from flu and “flu-related complications”[vi]. The most common “complication” is pneumonia, a bacterial (not viral) infection. The Center for Disease Control in the U.S. defines influenza-related deaths as “deaths that occur in people for whom seasonal influenza was a likely contributor, but not necessarily the primary cause of death.”[vii] The U.S. Bureau of Statistics lumps influenza and pneumonia together in their general stats, but then splits them out in the tables. For example in 2009, 2,808 people died of influenza in the U.S. and 50,774 died of pneumonia[viii] but the combined total is an alarming 53,582, which is the number generally reported. Given that the majority of ‘flu and flu-related’ deaths occur in the elderly and those who already have compromised immune systems[ix], and the vast majority of these people died of pneumonia, suggesting that they “caught the flu and died from it” is misleading.

So what we have here is an overstatement of the risk of catching the flu, an overstatement of the value of the vaccine to prevent catching the flu, and an overstatement of how many people actually die from the flu. Twist the figures enough and, like any torturer will claim, they’ll tell you what you want to hear. Or just be vague enough, and the consumer will fill in the gaps with what they think it all means.

[i] The word immunize means “to render immune” (dictionary definition), meaning you won’t get it. Many of us also interpret this word as a verb that means to get a vaccination. So this is kind of a “slippery” word. Advertisers like slippery words.
[v] If you read the fine print on the home page, although this looks a little like some sort of “official”—e.g., government--website, it’s actually drug giant GlaxoSmithKline’s puppy. This is also the website promoted in the above tv advert.

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